| NPI | 1952503492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 7400) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7400) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2026-09-14 |